Dental anxiety can be associated with state anxiety and dental procedure-related pain

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Dental anxiety can be associated with state anxiety and dental procedure-related pain

Dental anxiety (DA) and fear are major complexities for both patient and dental care providers. Several studies have reported that DA further leads to state anxiety (SA), a case of general fears, neuroticism and psychological distress, which is a great matter of concern.

Recently, a study was conducted to review clinical studies that exhibited dental anxiety (DA), state anxiety (SA) and pain among the patients undergoing dental treatment. In this study, three investigators analyzed PubMed and CINAHL databases to look for the literature assessing DA, SA, and pain before and after the dental treatment. Inclusion criteria included original research articles and studies involving patients who had received a surgical or nonsurgical dental treatment, studies that reported DA and pain as outcome variables, observational or experimental surveys and studies that reported SA. While studies on modifying pain or anxiety using a pharmacological intervention were excluded from the study.

Overall, 302 articles were extracted for further evaluation, while only 35 fulfilled the criteria of the research. These articles included 3184 patients from age group 21 to 58.7 years. Of 35, 25 studies were observational, and the rest were experimental. Diverse types of cases involved in the studies, for example, 19 studies were of tooth extraction, 11 of periodontal treatment and 5 of implant surgery.

The SA was measured with numerical Rating Scale and visual analog scale (VAS). On the other hand, DA was measured with Corah’s Dental Anxiety Scale which further followed by Short Dental Anxiety Inventory, Revised Dental Anxiety Scale, Dental Fear Survey, Modified Dental Anxiety Scale, Hierarchical Anxiety Questionnaire and a combined form of the Corah's Dental Anxiety Scale and Dental Fear Survey. The pain was assessed by either numerical Rating Scale or VAS. The scores for SA, pain, and DA were assigned to a 0 to 1 scale. Based on experiments, researchers proposed 11 hypotheses related to DA, SA, and pain.

The first hypothesis (H1) proposed that DA would not differ between surgical and nonsurgical treatments. For this, scientists executed a subgroup analysis, in which dental procedure took as categorical moderator and overall DA as the dependent variable (DV). Based on results, scientists found no difference in DA levels. The second hypothesis (H2), the measurement of the difference of SA was evaluated between treatment type. Same as DA, SA also showed no difference. In hypothesis 3 to 5, scientists proposed that DA would be a significant predictor of SA (before, during, and after treatment). To determine this, scientists modeled DA as covariate and SA as the DV. The results were measured with the slope of the regression. It was found that DA was the predictor of SA but only before and during the treatment.

Further, hypothesis 6-8 proposed that SA (before, during and after treatment) would be a significant predictor of expected pain. To analyze the relation, scientists took SA as covariate and pain as DV. The slope analysis showed SA as a significant predictor of pain only before the treatment.

In hypothesis, 9-11 proposed that DA might be a significant predictor of expected pain (before, during and after treatment). This time DA took a covariate and expected pain as DV. In this case, DA showed a statistically significant impact on pain at all stages of treatment.

Therefore, after analysis of all hypothesis, no difference was found in DA or SA between surgical and nonsurgical groups. The DA before and during the treatment was a significant predictor for SA. More, SA showed a powerful impact on expected pain only before the treatment. On the other hand, DA showed a great impact on pain before, during, and after the treatment.


The Journal of Evidence-Based Dental Practice

Link to the source:

The original title of the article:

Self-reported Dental Anxiety is Associated With Both State Anxiety and Dental Procedure-Related Pain


  Lisa J. Heaton

Exploratory, Dental pain, Teeth, NRS, VAS, Corah’s Dental Anxiety Scale, Revised Dental Anxiety Scale, Modified Dental Anxiety Scale, Hierarchical Anxiety Questionnaire
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